NCG100252_Representative Outfall Request_20210611

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Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
REPRESENTATIVE OUTFALL STATUS (ROS)
REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year Month pay
RECEIVED
JUN 0 0 2021
If a facility is required to sample multiple discharge locations with very similar stormwater disdWJ4.gRhjQU1
permittee may petition the Director for Representative Outfall Status (ROS). DWQ may grc4)TM i2"W
Outfall Status if stormwater discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted, ALL outfalls are still subject to the -qualitative monitoring
requirements of the facility's permit —unless otherwise allowed by the permit (such as NCG020000) and DWQ
approval. The approval letter from DWQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DWQ in writing if any changes affect representative status.
For questions, please contact the DWQ Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N C S N C G
2) Facility Information:
Owner/Facility Name LKQ Pick Your Part Southeast LLC d/b/a LKQ Pick Your Part- Greensboro
Facility Contact
Street Address
City
County
Telephone No.
Waldemar Sanchez Melendez
100 Ward Rd
Greensboro
Guilford
(704 492-5695
State NG
E-mail Address
Fax:
ZIP Code 27405
[e-mail]
3) List the representative outfall(s) information (attach additional sheets if necessary):
Outfall(s) 001 is representative of Outfall(s) 002, 003, and 004
Outfalls' drainage areas have the same or similar activities? Dyes JkNo
Outfalls' drainage areas contain the same or similar materials? EPYes 13No
Outfalls have similar monitoring results? O(Yes ONo 13No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
Outfalls' drainage areas contain the same or similar materials?
Outfalls have similar monitoring results?
Outfall(s)
is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
Outfalls' drainage areas contain the same or similar materials?
Outfalls have similar monitoring results?
ElYes
ONo
MYes
113No
DYes
13No ©No data*
Mes
O No
Mes
Mo
Mes
13No 13No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page 1 of 3
SWU-ROS-2009 Last revised 12/30/2009

Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example, describe how activities and/or
materials are similar.
All outfalls at the facility represent stored used vehicles for the automotive salvage
business. Exposed products at all outfalls include metal and petroleum. Draining,
dismantling, and crushing of automobiles is an activity that only occurs in the
Outfall 001 draining area, but this activity is covered from precipitation. Historic
sample analysis at sampled outfalls indicate sample results are similar.
5) Certification:
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record,
report, plan, or other document filed or required to be maintained under this Article or a rule implementing this
Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case
under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device
or method required to be operated or maintained under this Article or rules of the [Environmental Management]
Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed
ten thousand dollars ($10,000).
I hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DWQ in writing if any changes to the facility or its operations
take place after ROS is granted that may affect this status. if ROS no longer applies, I understand I must
resume monitoring of all outfalls as specified in my NPDES permit.
certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Waldemar Sanchez Melendez
Title: Plant Manager
A
(Signature 6f- *scant)
6/212021
(Date Signed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDENR Regional Office. The Regional Office may inspect your facility for compliance with the
conditions of the permit prior to that approval.
Final Checklist for ROS Reguest
This application should include the following items:
❑ This completed form.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
❑ Two (2) copies of a site Wrap of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
❑ Summary of results from monitoring conducted at the outfalls listed in Question 3.
❑ Any other supporting documentation.
Page 2 of 3
S W U-ROS-2009 Last revised 12/30/2009

WL Historic Sample Analysis
DE +r..nr.a . •n.­ar r.y.r_.
Sample Date
1 1 / 18/2014
Outfall
Outfall002
Parameter
Ethylene Glycol
Sample
Result
< 1.2
Unit
mg/L
11/18/2014
Oil and Grease
5.9
mg/L
11/18/2014
pH
7.01
S.U.
11/18/2014
Total Recoverable Lead
0.008
mg/L
11/18/2014
Total Suspended Solids
250 1
mg/L
10/26/2017 LKQ Pick Your Part Greensboro